Bergland Ellingsen Silje, Nordmo Elisabet, Lappegård Knut Tore
Division of Internal Medicine, Nordland Hospital, Bodø, Norway.
RELIS Nord-Norge (Regional Medicines Information Centre of North Norway), University Hospital of North Norway, Tromsø, Norway.
Clin Med Insights Case Rep. 2017 Sep 25;10:1179547617731375. doi: 10.1177/1179547617731375. eCollection 2017.
Severe hepatotoxicity is a rare but well-known adverse reaction to statins. However, despite the widespread use of statins, only a few cases describing statin reexposure or switch to another statin after liver injury have been published. The literature on hepatotoxicity with ezetimibe alone or in combination with statins is also scarce. We report a case where a patient with a history of elevated liver enzymes while using atorvastatin, but prior and subsequent good tolerance to simvastatin and pravastatin, developed drug-induced liver injury on reexposure to a combination of atorvastatin and ezetimibe. The hepatotoxicity in our patient was most likely caused by reexposure to atorvastatin, although we cannot exclude ezetimibe as a contributing factor. This case highlights the risk of hepatotoxicity recurrence on rechallenge with the same statin. The tolerance to other statins in this case also strengthens the suspicion that statin-induced liver injury may not be a class effect, although the current data are too scarce to draw any definite conclusions.
严重肝毒性是他汀类药物一种罕见但广为人知的不良反应。然而，尽管他汀类药物广泛使用，但仅有少数描述肝损伤后重新使用他汀类药物或换用另一种他汀类药物的病例被发表。关于依折麦布单独使用或与他汀类药物联合使用时肝毒性的文献也很稀少。我们报告了一例患者，该患者在使用阿托伐他汀时曾有肝酶升高史，但之前和之后对辛伐他汀和普伐他汀耐受性良好，在重新使用阿托伐他汀和依折麦布联合用药后发生了药物性肝损伤。我们患者的肝毒性很可能是由于重新使用阿托伐他汀所致，尽管我们不能排除依折麦布作为一个促成因素。该病例突出了再次使用相同他汀类药物时肝毒性复发的风险。该病例中对其他他汀类药物的耐受性也进一步加深了人们的怀疑，即他汀类药物所致肝损伤可能并非类效应，尽管目前的数据太少，无法得出任何明确结论。
